Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age. It can cause irregular menstrual cycles, excess hair growth, acne, and fertility challenges. For individuals with both PCOS and obesity, bariatric surgery offers a potential intervention to manage symptoms and improve overall health.
PCOS and Its Connection to Weight
PCOS is characterized by hormonal imbalances, often involving higher levels of androgens, typically considered male hormones. These disruptions can lead to symptoms such as irregular or absent periods, excess facial and body hair (hirsutism), and acne. Many individuals with PCOS also experience insulin resistance, where the body’s cells do not respond effectively to insulin. This prompts the pancreas to produce more insulin to manage blood sugar levels.
High insulin levels can stimulate the ovaries to produce more androgens, further worsening PCOS symptoms and making weight management difficult. Excess weight, particularly around the abdomen, is common and can exacerbate insulin resistance. This creates a cycle where weight gain contributes to PCOS symptoms, and hormonal imbalances make weight loss more challenging. Addressing weight plays a role in improving these interconnected health concerns.
Common Bariatric Surgery Procedures
Bariatric surgery encompasses several procedures designed to induce significant weight loss. Two common types relevant for individuals with obesity are Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG). These surgeries work by altering the digestive system to limit food intake, reduce nutrient absorption, or both.
Roux-en-Y Gastric Bypass involves creating a small stomach pouch, about the size of an egg, from the upper part of the stomach. This new pouch connects directly to a section of the small intestine, bypassing the larger part of the stomach and its initial section. This procedure restricts the amount of food that can be eaten and also reduces the absorption of calories and nutrients.
Sleeve Gastrectomy, on the other hand, involves removing a significant portion (around 75-80%) of the stomach, leaving a smaller, tube-shaped “sleeve.” This permanent reduction in stomach size limits the amount of food consumed. Removing a portion of the stomach also affects ghrelin production, a hunger-stimulating hormone, which can lead to a decrease in appetite.
How Bariatric Surgery Improves PCOS
Weight loss from bariatric surgery significantly improves PCOS symptoms. A primary mechanism is the improvement of insulin resistance. As weight decreases, the body’s cells become more responsive to insulin, leading to lower insulin levels. This reduction in insulin can decrease androgen overproduction by the ovaries, helping to rebalance hormones.
Improvements in hormonal balance often manifest as more regular menstrual cycles and a decrease in hyperandrogenism symptoms like excess hair growth and acne. The reduction in androgen levels, such as testosterone, and an increase in sex hormone-binding globulin (SHBG) are observed after surgery, contributing to these improvements.
Bariatric surgery can also enhance fertility for individuals with PCOS. By improving ovulation, the chances of spontaneous conception can increase. Studies indicate that women with PCOS who undergo bariatric surgery may experience higher pregnancy rates compared to those relying on traditional weight loss methods. These benefits extend to better pregnancy outcomes, including reduced risks of gestational diabetes and high birth weight.
Selecting the Right Surgical Approach for PCOS
Selecting the most suitable bariatric surgery for individuals with PCOS involves several factors, as no single “best” option exists for everyone. The choice depends on individual health profiles, co-existing medical conditions, and discussions with a specialized medical team.
RYGB offers significant and rapid weight loss, often improving conditions like type 2 diabetes and insulin resistance, which are closely linked to PCOS. The procedure’s ability to alter gut hormones and nutrient absorption contributes to these metabolic changes. However, RYGB carries a higher risk of nutrient malabsorption, requiring lifelong vitamin and mineral supplementation.
Sleeve Gastrectomy provides considerable weight loss and often improves insulin sensitivity and hormonal balance. It is generally considered less complex than RYGB, with a lower risk of long-term nutritional deficiencies because it does not involve bypassing a section of the small intestine. The choice between these procedures also weighs their respective risks, such as bleeding, infection, or bowel obstruction, which vary slightly by procedure. A comprehensive assessment with healthcare professionals, including bariatric surgeons and endocrinologists, is important to align the surgical approach with individual PCOS symptoms, overall health goals, and long-term well-being.